WBAs as a Bridge Between Theory and Practice

• Traditional classroom-based EBM teaching often fails to translate into clinical skills.
• WBAs enable students to apply EBM in real-time, working with actual patients.
• Integration of EBM into WBAs provides a continuous learning process, improving knowledge retention and clinical decision-making.

• Reference: Coomarasamy & Khan (2004): What is the evidence that postgraduate teaching in evidence based medicine changes anything?

Utilizing Case-Based Learning to Apply EBM

• Benefits:
  • Enhances critical thinking and decision-making skills.
  • Bridges the gap between theory and clinical practice.
  • Fosters teamwork and communication among learners.
• Case-based learning significantly improves EBM knowledge and application.

• Reference: Young T, Rohwer A, Volmink J, Clarke M. What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews.

Benefits of Clinical Integration of EBM through WBAs

• Increases clinical relevance: Students apply PICO questions directly related to patient care.
• Improves retention: WBAs reinforce the application of EBM principles in real clinical scenarios, improving retention compared to standalone methods.
• Enhances behavior: Clinically integrated WBAs lead to better behavior change, such as literature review habits and evidence application.

• Reference: Coomarasamy & Khan (2004): What is the evidence that postgraduate teaching in evidence based medicine changes anything?

Essential Components of EBM in WBAs

• Problem Formulation: Students develop clinically relevant PICO questions during rounds.
• Critical Appraisal: Students assess literature for relevance and validity directly in patient care scenarios.
• Application: EBM findings are immediately applied to patient management, bridging theory and practice.

• Reference: Kasai et al. (2024): Effect of a workplace-based learning program on clerkship students’ behaviors and attitudes toward evidence-based medicine practice.

Structured Feedback and Reflection in WBAs

• Structured Feedback: Feedback on EBM presentations helps students refine their skills and improve their understanding of clinical applicability.
• Reflection: Encouraging students to reflect on their EBM processes reinforces continuous learning and helps integrate evidence into future patient care.

• Reference: Kasai et al. (2024): Effect of a workplace-based learning program on clerkship students’ behaviors and attitudes toward evidence-based medicine practice.

Challenges in Implementing EBM as a WBA

• Time Constraints: Faculty often struggle to integrate EBM teaching into busy clinical schedules.
• Varying Student (and faculty) Preparedness: Differences in prior EBM knowledge can impact the effectiveness.
• Sustaining Long-Term Behavior Change: EBM behavior may diminish over time without continuous reinforcement.

Students’ Perspective on EBM Teaching in WBAs

• Positive Reception: A systematic review found that students generally have a positive perception of learning EBM through practical applications.
• Increased Engagement: WBAs make EBM more engaging as students actively formulate clinical questions and apply evidence to real patients.
• Improved Skills: Evidence shows improved critical thinking and decision-making skills when students are assessed via WBAs that integrate EBM principles.

• Reference: Effectiveness of Teaching Evidence-Based Medicine to Undergraduate Medical Students: A BEME Systematic Review (2024).

Importance of Asking Answerable Questions

• EBM Foundation: The first step in EBM is formulating clear, answerable clinical questions using the PICO framework (Patient, Intervention, Comparison, Outcome).
• Types of Questions:
  • Background: General knowledge about a condition or intervention.
  • Foreground: Specific knowledge to inform clinical decisions (PICO format).
• Example:
  • P: Patient with hypertension, I: Lifestyle changes, C: Medication, O: Blood pressure reduction.

• Reference: How to Practice and Teach EBM: Asking answerable questions is a crucial skill in EBM (Chapter 1).

Teaching Strategies for Asking Better Questions

• Role Modeling: Faculty should demonstrate the process of turning clinical uncertainty into answerable questions during rounds.
• Interactive Methods: Group activities where students formulate and refine clinical questions with peer and mentor feedback.

• Reference: How to Practice and Teach EBM (Chapter 1): Role modeling and interactive teaching enhance question formulation skills.

Acquiring the Best Evidence for EBM

• Key Resources: Teach students how to efficiently use preappraised sources (e.g., Cochrane, UpToDate) for quick evidence retrieval.
• Search Strategies: Focus on systematic and strategic search techniques (e.g., using Boolean operators, medical subject headings (MeSH)) to find relevant studies.
• Understanding Study Hierarchy: Would prefer studies with inherently lower risk of bias.

• Reference: How to Practice and Teach EBM (Chapter 2): Effective use of evidence sources is critical to successful EBM presentations.

Appraising Evidence: Levels of Evidence

Teaching the Evidence Search Process

• Educational Prescriptions: Assign students clinical questions and guide them through the search process to find answers.
• Practical Exercises: Incorporate case-based learning where students are required to locate and appraise evidence for their cases.

• Reference: How to Practice and Teach EBM (Chapter 2): Effective teaching involves guiding students through the evidence search process.

Appraising Evidence for EBM Presentations

• Critical Appraisal: Teach students how to evaluate the validity, relevance, and applicability of research.
• Key Appraisal Criteria:
  • Study Design: experimental vs. observational studies.
  • Bias Assessment: How to detect selection bias, performance bias, and publication bias.
  • Strength of Evidence: Use established tools like GRADE to assess evidence quality.

• Reference: How to Practice and Teach EBM (Chapter 3): Critical appraisal is essential for applying evidence effectively.

Understanding study type and its analysis

GRADE to assess risk of bias

GRADE Assessment Training from Cochrane

Enhancing Students’ Appraisal Skills

• Group Appraisal Sessions: Encourage group discussions and collaborative appraisal to improve skills.
• Use of Checklists: Introduce students to critical appraisal checklists (e.g., CASP, CONSORT) to structure their evaluations.

• Reference: How to Practice and Teach EBM (Chapter 3): Collaborative appraisal improves students’ understanding and application of evidence.

CASP for critical appraisal

CASP checklists for critically appraising an article